can perform wire needle localization of non-palpable lesions detected by mammography which are not seen on ultrasound

can use same procedure of stereotactic biopsy to place a hook wire in the center of the lesion

following the excision, can do specimen mammography to ensure that there is an adequate margin by comparing the specimen mammogram with the preoperative mammograms

the suspicious lesion may be just a cluster of microcalcifications

in such cases, we need to be careful evaluating adequate margins on specimen mammogram

in lesions seen on mammography, needle placement can be done under sonographic guidance. In such cases, intraoperative sonography can be performed to assess complete removal

ultrasound-guided FNAC/biopsy can be performed preoperatively.

recent technique of radionuclide localization (ROLL) is emerging as an adjunct.

Triple assessment

To be convinced a lesion is benign, the lesion has to always be benign/innocuous on

clinical exam

breast imaging, i.e. mammography, ultrasound and or MRI or a combination of each

tissue sampling (cytology or histology)

If one of the three bullets above is not satisfied, the lesion cannot simply be called benign. If the lesion is clinically suspicious and even if imaging is negative, cytology is indicated. If the lesion is palpable and not seen on mammogram ultrasound is mandatory and unless the ultrasound is convincingly benign, tissue sampling is indicated.